Computed Tomography Features of COVID-19 in Children: A Systematic Review and Meta-analysis

Abstract

Objectives: To systematically analyze the chest CT imaging features of children with COVID-19 and provide references for clinical practice. Methods: We searched PubMed, Web of Science, and Embase; data published by Johns Hopkins University; and Chinese databases CNKI, Wanfang, and Chongqing Weipu. Reports on chest CT imaging features of children with COVID-19 from January 1, 2020, to August 10, 2020, were analyzed retrospectively and a meta-analysis carried out using Stata12.0 software. Results: Thirty-seven articles (1747 children) were included in this study. The overall rate of abnormal lung CT findings was 63.2% (95% confidence interval [CI]: 55.8-70.6%), with a rate of 61.0% (95% CI: 50.8-71.2%) in China and 67.8% (95% CI: 57.1-78.4%) in the rest of the world in the subgroup analysis. The incidence of ground-glass opacities was 39.5% (95% CI: 30.7-48.3%), multiple lung lobe lesions 65.1% (95% CI: 55.1-67.9%), and bilateral lung lesions 61.5% (95% CI: 58.8-72.2%). Other imaging features included nodules (25.7%), patchy shadows (36.8%), halo sign (24.8%), consolidation (24.1%), air bronchogram signs (11.2%), cord-like shadows (9.7%), crazy-paving pattern (6.1%), and pleural effusion (9.1%). Two articles reported three cases of white lung, another reported two cases of pneumothorax, and another one case of bullae. CONCLUSION: The lung CT results of children with COVID-19 are usually normal or slightly atypica, with a low sensitivity and specificity compared with that in adults. The lung lesions of COVID-19 pediatric patients mostly involve both lungs or multiple lobes, and the common manifestations are patchy shadows, ground-glass opacities, consolidation, partial air bronchogram signs, nodules, and halo signs; white lung, pleural effusion, and paving stone signs are rare. CLINICAL IMPACT: Therefore, chest CT has limited value as a screening tool for children with COVID-19 and can only be used as an auxiliary assessment tool.

COVID‐19 and pediatric pulmonology: Feedback from an expert center after the first year of the pandemic

“…), CT pulmonary angiography should be performed to identify COVID‐19 complications, such as ARDS and pulmonary embolism. A meta‐analysis of the CT scans of 1747 children with COVID‐19 found 63.2% of abnormalities on chest CT, including 39.5% of ground‐glass opacities and 65.1% of bilateral lung lesions, but also rare abnormalities, such as pulmonary nodules (25.7%), patchy shadows (36.8%), halo signs (24.8%), consolidation (24.1%), air bronchogram signs (11.2%), cord‐like shadows (9.7%), crazy‐paving pattern (6.1%), and pleural effusion (9.1%) 51 . Compared to adults, ground‐glass opacities are less frequently reported, as is the bilaterality of lesions 52 .…”

“…A meta-analysis of the CT scans of 1747 children with COVID-19 found 63.2% of abnormalities on chest CT, including 39.5% of ground-glass opacities and 65.1% of bilateral lung lesions, but also rare abnormalities, such as pulmonary nodules (25.7%), patchy shadows (36.8%), halo signs (24.8%), consolidation (24.1%), air bronchogram signs (11.2%), cordlike shadows (9.7%), crazy-paving pattern (6.1%), and pleural effusion (9.1%). 51 Compared to adults, ground-glass opacities are less frequently reported, as is the bilaterality of lesions. 52 It is also important to note that pulmonary embolism must be considered in adolescents, especially in cases of thromboembolic risk factors or suggestive biological markers.…”

COVID‐19 implications for pediatric anesthesia: Lessons learnt and how to prepare for the next pandemic

“…Chest radiograph or computed tomography (CT) of chest often present with near normal or at least less abnormal findings compared with adults. 10,11 Our knowledge about the benefits and safety of SARS-CoV-2 vaccines for children are essential not only due to safety issues but also because of our role as health-care providers since many parents may have questions, hesitations, and concerns that may affect their acceptance of vaccines in children. Some children may even need sedation or anesthesia for vaccination.…”

“…The above‐associated conditions obviously pose considerable risk for children in need of anesthesia and critical care. Chest radiograph or computed tomography (CT) of chest often present with near normal or at least less abnormal findings compared with adults 10,11 …”